This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The increase in obesity among U.S. children portends a rise in high blood pressure and heart disease, which threaten to wipe out gains made in the last decades. Heart disease may no longer be a disease of older adults. To address this growing need, Mt. Washington Pediatric Hospital in Baltimore offers a multi-disciplinary intervention program, Weigh Smart, targeting children and adolescents who are overweight and obese which includes family nutrition education, psychological counseling for children and their families and on-site exercise sessions. As a result of participation in the Weigh Smart program, some children will lose weight, but all will increase their activity level and change their eating pattern to some degree. These strategies may be important to counteract the effects of obesity and may ameliorate early signs of cardiovascular disease. We plan to study children before and after they participate in the Weigh Smart program. We will evaluate their blood pressure using a wearable blood pressure device. Blood and urine tests of early cardiovascular disease will be evaluated before and after the program to better understand the earliest mechanisms of heart disease from obesity.